Nelson Marquez, PT, EdD, Physical Therapy Editor

Nelson Marquez, PT, EdD, Physical Therapy Editor

A couple of weeks ago, I was requested by our school administrators to work on assessing the effectiveness of one of our campus initiatives called “My Brother’s Keeper.” This project was initiated three years ago to address the needs of homeless students enrolled in our institution.

My orientation to the project and interviews with the managers of the project proved to be an eye opener. I learned first-hand the magnitude of the issue of homelessness among students – their staggering number, the coping mechanisms they employ to hide from being discovered and the impact of their status on their ability to complete their education.

I also learned how to recognize the signs of homelessness among students as it manifests differently compared to our stereotype of homeless individuals. It is more subtle among students. For example, they are still well-kept when they attend school but they may be wearing the same attire everyday. Some classmates may have observed the student washing and bathing in the school’s restrooms early in the morning and loitering after hours on campus.

Recently, while working in an outpatient clinic, I was alerted by the administrative assistant that a homeless man had been loitering around the clinic for the last few days, pacing back and forth, and staring at the window of the clinic. According to the staff, he seems to be reading the sign on the window, indicating the physical therapy services provided in the facility. The staff asked me to speak to the man, as they feel that his presence outside the clinic was making the patients in the waiting area uncomfortable.

One glance and I knew that he was homeless; it wasn’t as subtle as those manifested by homeless students. He fit the profile that the My Brother’s Keeper team at my school taught me. He was carrying a plastic garbage bag full of his belongings. It was also obvious that he hadn’t bathed in days.

In between patients, I went out to speak to him and led him into the clinic. I offered him a patient gown, showed him the clinic’s restroom so that he can clean up and instructed him to wait in one of the treatment cubicles. You can just imagine the stares that I received from the other patients and the PT staff, seemingly asking, “What do you think you are doing?”

Before I can explain to the staff, the homeless man had stepped out of the restroom, clad in his disposable gown. I requested a blank sheet of paper from the administrative staff and wrote on top of it: PT Evaluation, followed by the acronym SOAP, with each letter evenly spaced on the page. I also left a space on top of the page for me to write the man’s demographic information: name, age, gender, etc.

When I spoke with my new patient before accommodating him in the clinic, I learned that he had lost his job and his home six months ago. He had stayed in a homeless shelter during the night but was in the streets during the day. A couple of weeks ago, his back went out. He attributed this from carrying his heavy belongings throughout the day. He reported that his low back pain was so excruciating that he cannot sit for even short periods of time.

He found this condition to be a detriment to his finding employment as prospective employers denied him upon discovery of his condition. This was the reason why he kept pacing outside the clinic the last few days. He knew that he needed to seek physical therapy intervention, but he did not have insurance or cash to pay for the service. He also told me that he would rather go to a physical therapist than a chiropractor and was able to describe the difference between the two. He explained that while he was still employed, his employer’s health insurance included PT coverage and that he was able to take advantage of this benefit.

My PT evaluation revealed that he had SIJ dysfunction. After an hour of focused postural realignment, mobilizations and stabilization exercises, my patient emerged from the treatment cubicle like a new person: upright, instead of stooped with the head down; smiling instead of frowning with a worried look on his face. His pain level had significantly dropped.

He left the clinic dressed with a semi-wrinkled button-down shirt, a tie and a pair of trousers that he dug up from his plastic bag. He said that he was going for another interview that afternoon.

After he left, the administrative staff asked me how we will charge for the PT service that I provided him, including the evaluation. I told them to deduct three hours worth of my salary for the day to cover for that service. When the staff asked me why I did what I had done, I simply replied: “Because I am my brother’s keeper.”

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